Project 1: Break Free: Effectiveness of a multi-level smoking cessation program adapted for high-risk women in rural communities

项目摘要--项目1 在阿巴拉契亚许多服务不足的社区，吸烟率(25%-35%)几乎是 在全国范围内发病率高，是该地区宫颈癌高风险的主要因素。项目1--《挣脱》 (BF)将实施并测试医疗服务提供者和训练有素的患者导航员提供的服务的有效性 旨在综合宫颈癌范围内降低宫颈癌风险的戒烟干预 预防计划。BF是该团队之前在调整基于证据的吸烟方面工作的结果 将对农村人口实施戒烟计划，并将进行测试、改进和实施，以实现高影响力和 通过可收费的成本回收实现可持续性。BF使用临床交付的标准格式ASK、ADVIST和 连接(AAC)，然后进行4次积极的电话咨询和尼古丁替代 为600名成年女性吸烟者在10个非重叠健康的初级保健实践中提供治疗支持 阿巴拉契亚地区四个州(肯塔基州、俄亥俄州、弗吉尼亚州、西弗吉尼亚州)的系统。BF将扩大到所有符合条件的吸烟者 在可持续发展阶段。将对延迟干预和早期干预的卫生系统组进行比较。项目1 通过提供集成的CLANCE的关键组件，与整体计划项目密切协调 癌症风险降低/预防计划及其总体成果，并将依赖于其共享的核心 协调其执行、衡量、评价和传播进程。项目1的目标是 按照三个不同的结果级别组织：1)服务结果：确定核心的有效性 一项旨在帮助女性吸烟者戒烟的综合宫颈癌预防计划的组成部分 标准化临床实践支持和协议；2)客户结果：确定对多项服务的满意度 层级干预；3)实施结果：通过以下方式测试多层级干预的可持续性 就循证戒烟服务的咨询和计费对提供者和工作人员进行培训。 在参与卫生系统的阿巴拉契亚农村诊所的不同集合中成功实施BF 在4个州提出的，有可能通过改善农村患者的健康状况而产生重大和持续的影响 获得高质量、对文化敏感和以当地证据为基础的戒烟治疗。如果成功 在临床一级被证明是可持续的，BF可以在阿巴拉契亚农村地区以及 到其他服务不足的地理环境中的医疗系统。

PROJECT SUMMARY – PROJECT 1 The prevalence of smoking (25 – 35%) in many underserved Appalachia communities is nearly double the national rate and is a major contributor to the high-risk for cervical cancer in the region. Project 1 – `Break Free' (BF) will implement and test the effectiveness of a healthcare provider- and trained patient navigator-delivered smoking cessation intervention designed to reduce cervical cancer risk within an integrated cervical cancer prevention program. BF is the result of previous work of the team in adapting an evidence-based smoking cessation program to rural populations and will be tested, refined and implemented to achieve high impact and sustainability through billable cost-recovery. BF utilizes a standard format of clinical delivery of Ask, Advise and Connect (AAC) followed by 4 sessions of proactive telephone-based counseling with Nicotine Replacement Therapy support delivered to 600 adult female smokers in primary care practices of 10 non-overlapping health systems in the Appalachian region of four states (KY, OH, VA, WV). BF will be extended to all eligible smokers in the sustainability phase. Delayed versus early intervention health system groups will be compared. Project 1 is closely coordinated with the overall Program Project by providing a key component of an integrated cervical cancer risk reduction/prevention program and its overall outcome and will rely on its shared Cores for harmonization in its implementation, measurement, evaluation and dissemination processes. Project 1 aims are organized along three distinct levels of outcomes: 1) Service outcomes: Determine the effectiveness of a core component of an integrated cervical cancer prevention program designed to help female smokers quit by standardizing clinical practice supports and protocols; 2) Client outcomes: Determine satisfaction with the multi- level intervention; and 3) Implementation outcomes: Test the sustainability of the multi-level intervention via training of providers and staff on counseling and billing for evidence-based smoking cessation services. Successful implementation of BF in the diverse set of rural Appalachian clinics in participating health systems proposed, across 4 states, has the potential for a substantial and sustained impact by improving rural patients' access to high quality, culturally sensitive, and local evidence-based smoking cessation treatment. If successfully shown to be sustainable at the clinic level, BF could be disseminated widely within rural Appalachia, as well as to healthcare systems in other underserved geographic settings.